In social care ‘equity’ is often used but rarely defined. As the sector prepares for reform, it’s clear we need a better understanding otherwise efforts to improve outcomes risk reinforcing.
Why a definition matters?
While the NHS has long used the concept of equity to mean fairness and the absence of avoidable differences, social care has lacked a comparable definition. This gap has real consequences. As Dr Clenton Farquharson CBE put it, ‘The current social care system is not set up in a way which provides equity of access’. In other words, people’s chances of getting the care they need can vary wildly based on factors like where they live, their income, or their background.
The Social Care Institute for Excellence (SCIE) has recently been undertaking work in this area, including creating a Social Care Equity ‘Evidence Hub’ to highlight this. A central part of SCIE’s work has been to co-produce a working definition of equity in social care. Developed with people who use services, carers, professionals, and researchers, the definition aims to reflect lived realities as well as policy goals.
According to the SCIE Evidence Hub project team (Deborah Rozansky, Matthew Ford and Tasnim Rahman), ‘Having a clear definition of equity in social care isn’t just a technicality, it gives us a shared foundation to challenge unfairness and focus on what needs to change.’
This shared understanding is now more important than ever. The Care Quality Commission (CQC) has begun assessing local authorities and care providers against new quality statements that explicitly refer to equity in access, experience, and outcomes. Without a clear definition, efforts to improve equity risk being inconsistent or superficial. A common framework helps providers, commissioners, and inspectors ask the right questions and focus improvement efforts where they are most needed.
The working definition
SCIE’s working definition of equity in social care is inspired by the World Health Organisation’s definition of health equity. The definition states:
‘Equity in social care means the absence of unfair, avoidable, or remediable differences in access to, experience of, or outcomes from care and support among groups of people – whether defined by social, economic, demographic, or geographic factors, or by characteristics such as sex, gender, ethnicity, disability, or sexual orientation.’
The definition also aligns with the core principles of personalisation, prevention and wellbeing found in the Care Act of 2014. Achieving equity means that support should be matched to individuals’ needs, and that services are designed and delivered in a way that removes barriers, reduces disadvantage, and respects people’s circumstances. This includes, but goes beyond, access, it also covers how people are treated, whether services are inclusive and appropriate, and whether they lead to meaningful improvements in people’s lives.
A framework for understanding equity
To make equity actionable, the team have also co-produced a visual framework (named the ‘experimental rainbow’) to map the factors contributing to inequities in social care. The components of the framework were drawn from available literature and adapted from the Dahlgren-Whitehead model of health determinants. Six interconnected layers that shape people’s experiences of care are set out, with each layer interacting with the others. The model illustrates how disadvantage affecting individuals can also be accumulative. For example, a person with learning disabilities, low income (socioeconomic disadvantage), and limited digital access (cultural/behavioural), living in an area with under-resourced services (local system), is likely to face greater barriers than someone with similar needs elsewhere.
Image: the Experimental Rainbow supplied from SCIE
Demographic factors such as ethnicity, gender, and disability cut across all layers and can compound inequities in care access, experiences and outcomes if not explicitly addressed. By broadening our understanding of where our current care system results in care inequities, the framework helps shift thinking from individual factors to structural causes of inequities.
The framework also aligns with how equity is assessed in local authority inspections. Under the CQC’s new regulatory approach under the Single Assessment Framework, equity is embedded in quality statements that assess whether services are good and person-centred. Our framework offers care providers and local authorities a way to understand and evidence these requirements, clarifying where action is needed and how to meet the regulator’s expectations.
The cost of inaction
Failing to act on inequity has real-world consequences. Around 2 million older people in England are estimated to have unmet care needs. Meanwhile, access to care varies dramatically by postcode. In some areas, over 80% of people requesting care receive no service. Inequity also affects quality. For example, people from minority ethnic backgrounds report poorer experiences and lower satisfaction with services.
This isn’t just about fairness, it’s also about effectiveness. Unmet need leads to poorer health, greater isolation, and eventually higher costs to the NHS. These outcomes are not inevitable; they are the result of a fragmented system that too often fails to personalise care, leaving many without the support they need. Good social care should enable people to live ‘gloriously ordinary lives’ – lives with choice, dignity, and participation.
The Casey Commission, due to report in 2028, presents a rare chance to rethink adult social care. Equity must be at the heart of this. If we want a system that supports everyone fairly, regardless of their postcode, background, or the funds available to them, then we need to build that aim into how services are funded, designed, and delivered.
What SCIE’s Social Care Equity Evidence Hub will do
The Social Care Equity Evidence Hub, due to be published in Autumn 2025, brings together research, data, and case studies on where inequities exist and what can be done to reduce them. It also highlights what works in practice, such as targeted outreach, accessible service design, or inclusive commissioning, and who is being left behind. But there are many research gaps, and the design of practical interventions will require further study.
By assembling data, case studies, and research in one place, the Hub will support everyone, from councils to care organisations, to make informed decisions through an equity lens. The team behind the project said, ‘Resources like the evidence hub will ensure solutions are informed by data and lived experiences, not just assumptions, a vital step if we are to move from talking about fairness to actually achieving it.’
By giving professionals and policymakers a clearer view of the landscape, the hub will help move the equity conversation from principle to practice. We expect to use the evidence contained within the Hub as a benchmark for tracking whether new policy reforms, like those expected from the upcoming Casey Commission, will help or hinder care equity – and whether we’re on the right track to achieve a fairer system for all.
This kind of intelligence is essential if we are to move beyond good intentions and deliver a care system that genuinely works for all. In a time of scarce resources and high need, focusing on equity is not optional. It’s the only way to make sure that the care system works for those who rely on it most.
This article was written by Matthew Ford, Research Analyst at SCIE.
Feature photo by Amy Elting via UnSplash
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